Paediatric urology services including management of VUR, posterior urethral Valves, ureterocoeles, hypospadias and all other types of congenital and acquired urological abnormalities in children

VUR

Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the kidneys. Normally, urine flows from the kidneys through the ureters to the bladder. The muscles of the bladder and ureters, along with the pressure of urine in the bladder, prevent urine from flowing backward through the ureters.

VUR allows bacteria, which may be present in the urine in the bladder, to reach the kidneys. This can lead to kidney infection, scarring, and damage.

This can be treated by

- Medication

- Surgery - A surgeon may need to create new valves for the ureters to prevent the backflow of urine.

POSTERIOR URETHRAL VALVES

PUV is an abnormality of the urethra, which is the tube that drains urine from the bladder to the outside of the body for elimination. The abnormality occurs when the urethral valves, which are small leaflets of tissue, have a narrow, slit-like opening that partially impedes urine outflow.

There are three specific endoscopic treatments of posterior urethral valves:

- Vesicostomy followed by valve ablation - a stoma, or hole, is made in the urinary bladder, also known as low diversion, after which the valve is ablated and the stoma is closed.

- Pyelostomy followed by valve ablation - stoma is made in the pelvis of the kidney as a slightly high diversion, after which the valve is ablated and the stoma is closed.

- Primary (transurethral) valve ablation - the valve is removed through the urethra without creation of a stoma.

URETEROCELES

A ureterocele is a congenital abnormality found in the ureter. In this condition the distal ureter balloons at its opening into the bladder, forming a sac-like pouch. It is most often associated with a duplicated collection system, where two ureters drain their respective kidney instead of one.

Surgical therapy for both pediatric and adult ureteroceles may include endoscopic puncture, incision or transurethral unroofing of the ureterocele, upper pole heminephrectomy, excision of ureterocele and ureteral reimplantation, and nephroureterectomy.

HYPOSPADIAS

Hypospadias is a male birth defect in which the opening of the tube that carries urine from the body (urethra) develops abnormally, usually on the underside of the penis. The opening can occur anywhere from just below the end of the penis to the scrotum.

Hypospadias is fixed with surgery. The goal of any type of hypospadias surgery is to make a normal, straight penis with a urinary channel that ends at or near the tip. The operation mostly involves 4 steps:

- Straightening the shaft

- Making the urinary channel

- Positioning the meatus in the head of the penis

- Circumcising or reconstructing the foreskin

Hypospadias repair is often done in a 90-minute (for distal) to 3-hour (for proximal) same-day surgery. In some cases the repair is done in stages. These are often proximal cases with severe chordee. The urologist often wants to straighten the penis before making the urinary channel.